Natural Penicillin

Penicillin

Strep (except some S. pneumo)

Enterococcus (only cidal in combo with aminoglycoside)

Treponema pallidum

Oral Anaerobes

Aminopenicillin

Ampicillin/Amoxacillin

Same as natural penicillin PLUS:

Listeria

E. coli, Proteus, H. flu

Lyme

Aminopenicillin + beta-lactamase inhib Ampicillin/Sulbactam

Amoxacillin/Clavulanate

Same as aminopenicillin PLUS:

MSSA

Beta-lactamase producing H. flu, Klebsiella, E. coli

B. fragilis (Gram negative Anaerobes)

Penicillinase-Resistant Penicillins

Nafcillin

Oxacillin

Dicloxacillin

MSSA

Strep (except S. pneumo)

*note the hepatic elimintation; no adjustments needed for renal insufficiency

Ext'd Spectrum Penicillin + beta-lactamase inhib

Ticarcillin/Clavulanate (rarely used)

Piperacillin/Tazobactam

MSSA

Strep (except S. pneumo)

Enterococcus

Pseudomonas (Gram negative Aerobes)

B. Fragilis

1st Gen Cephalosporins

Cefazolin

Cephalexin

Cefadroxil

MSSA

Strep

SOME E. coli, Klebsiella

Oral Anaerobes

*skin/soft tissue infections, surgical prophylaxis; NOT for sinusitis, otitis media, or LRIs (b/c they tend to be Gram negative)

2nd Gen Cephalosporins (2A)

Cefuroxime

Cefaclor

Cefprozil

MSSA

Strep

SOME E. coli, Klebsiella, H. flu

Oral Anaerobes

*increased Gram negative activity (H. flu) allows for use in sinusitis, otitis media

2nd Gen Cephalosporins

Cefoxitin

Strep (moderate)

SOME E. coli, Klebsiella, H. flu

Oral Anaerobes

B. fragilis

*anaerobic coverage (B. fragilis) allows for use in pelvic/intra-abdominal infxn

3rd Gen Cephalosporins

Ceftriaxone (biliary elim'n)

Cefotaxime

Cefixime

Cefpodoxime

Cefdinir

Ceftibuten

MSSA (moderate)

Strep

Gram negative Aerobes (expect Pseudomonas)

Oral Anaerobes

*ceftriaxone, cefotaxime for CA-meningitis, N. gonorrhea, neuro Lyme

3rd Gen Cephalosporin

Ceftazidime

Pseudomonas

3rd Gen Cephalosporin

Ceftaroline

MRSA

Strep

Gram negative Aerobes (except Pseudomonas)

Oral Anaerobes

*basically, Ceftriaxone + MRSA

4th Gen Cephalosporin

Cefepime

MSSA

Strep

Pseudomonas

Oral Anaerobes

Monobactam

Aztreonam

Pseudomonas

*good for patients with allergies to other beta-lactams

Carbapenem

Imipenem/Cilastatin

Meropenem

Doripenem

MSSA

Enterococcus

Pseudomonas

B. fragilis

*imipenem = seizures in patients w/ poor renal fxn

Carbapenem

Ertapenem

Gram negative Aerobes (except Pseudomonas)

B. fragilis

Glycopeptide

Vancomycin

MRSA/MRSE (cidal)

Enterococcus (static)

C. diff (Gram positive Anaerobes)

*rash/hypotension w/ fast infusion, nephrotoxicity

*use exclusively for Gram positive infxn, esp. C. diff diarrhea

Glycopeptide

Televancin

MRSA/MRSE (cidal)

Enterococcus (static)

C. diff

*basically same as vancomycin, but higher nephrotoxicity

Inhibitors of DNA/RNA Synth

Trimethoprim/Sulfamethoxazole (Bactrim)

MRSA/MRSE

Gram negative Aerobes (except Pseudomonas)

Nocardia

Pneumocystis jiroveci (PCP)

Toxoplasma gondii

*rash, hyperkalemia, mild creatinine elvation

*UTI is one of many uses

Inhibitors of DNA/RNA Synth

Rifampin

N. meningitidis (prophylaxis)

M. tuberculosis

Staph endocarditis

Infections of prostheses

*red/orange urine, hepatotoxicity

*NEVER use as monotherapy

*MANY drug interactions

Inhibitors of DNA/RNA Synth

Fidaxomicin

C. diff infxn is only use

Quinolone

Ciprofloxacin

Levofloxacin

Moxifloxacin

S. pneumo (Moxi and Levo)

Pseudomonas (Cipro and Levo)

B. fragilis (Moxi)

Chalmydia, Mycoplasma, Legionella (atypicals)

*CNS effects, tendon rupture, C. diff infxn

*used for UTI, prostatitis, Resp Tract/GI/Bone/Joint infxns, STDs

Aminoglycoside

Gentamicin

Tobramycin

Amikacin

Strep/Staph (moderate)

Enterococcus (cidal with beta-lactam)

Pseudomonas (genta>tobra>amik)

*nephrotoxic, ototoxic

*used with beta-lactam for staph/strep/enterococcal endocarditis; also used as "double coverage" for SEVERE Gram negative infxn

Macrolides

Azithromycin

Carithromycin

MSSA

Strep pneumo

H. flu, N. gonorrhea, M. catrrhalis, Campylobacter, H. pylori

Legionella, Chlamydia, Mycoplasma (atypicals)

Anaerobes (but NOT B. fragilis)

*VTach with Clarith; also, more drug interactions with Clarith (b/c it's metabolized by CYP)

*good for atypical pathogens and CA-pneumonia; also, otitis/sinusitis

Tetracyclines

Tetracycline

Doxycyline

Minocycline

Strep pneumo

Staph

Enterococcus

H. flu, N. gonorrhea, M. catarrhalis, Campylobacter

Legionella, Mycoplasma, Chlamydia (atypicals)

Lyme, Rickettsia

*discoloration of teeth in kids, GI ulceration; use in hospital is limited; best for outpatient treatment of URI

Glycylcycline

Tigecycline

MRSA, VRE

Gram negative Aerobes (except Pseudomonas)

B. fragilis

*tooth discoloration in kids and GI ulceration

*NOT for bacteremia

Lincosamide

Clindamycin

Staph, Strep

Gram negative Anaerobes (except B. fragilis)

*often leads to C. diff colitis

*use only for skin/soft tissue/oral infxn in people with penicillin allergy OR as combo therapy for necro fasciitis (GAS)

Oxazolidinone

Linezolid

MRSA, VRE

*use for resistant Gram positive infxn

*myelosuppression and serotonin syndrome

DNA Damaging

Nitrofuantoin

Gram positive Aerobes, including VRE

E. coli

*GI and pulmo side effects

*use only for UTI (but NOT pyelonephritis)

DNA Damaging

B. fragilis

Trichomonas

Giardia

H. pylori

C. diff

*best for anaerobic infxn

*also, see fungal and parasite lectures

Lipopeptide

Daptomycin

All Strep

MSSA, MRSA, MRSE

VRE

*NOT for pneumonia

*use for Gram positive bacteremia that is refractory to other treatment

*dose adjust for renal insuff

Polymyxin

Polymyxin B

Colistin

Pseudomonas

*last resort for resistant Gram negative infections (especially aerobic)

*dose adjust for renal insuff